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Medicare Part D Updates - 2024

Published on October 16, 2023 by Michelle Berney

Medicare Part D Updates

The following are significant changes to Medicare Part D prescription drug coverage in 2024:

·        Partial Extra Help (Low Income Subsidy Program, LIS) Eliminated in 2024: All individuals with Partial Extra Help will be transitioned to Full Extra Help effective January 1, 2024.  Full Extra Help offers more comprehensive cost-sharing assistance, allowing someone to select a benchmark Part D plan for $0 monthly premium, $0 deductible, and low copays for drugs on the plan’s formulary. 

·        Catastrophic Coverage: Full Drug Cost Relief at $8,000 TrOOP: Beneficiaries who reach the catastrophic stage of drug coverage, with true out-of-pocket (TrOOP) reaching $8,000, will have no cost sharing for any medications on their plan’s formulary for the remainder of the calendar year.  The medicare.gov planfinder will calculate this change for all beneficiaries, including those with Extra Help (LIS) whose drug costs put them into the catastrophic coverage period.   

·        Zero Cost Vaccinations: Vaccines recommended by ACIP (American Council of Immunization Practices) which are covered by Part D will be covered at 100%, meaning that beneficiaries will have $0 cost sharing if they use a pharmacy that in in their plan’s network.  Vaccines covered by Part D include shingles and tetanus-diphtheria-whooping cough. With this change, vaccines covered by Part D are in line with those covered by Part B, with beneficiaries having no out-of-pocket costs for coverage.

·        Affordable Insulin Coverage: Insulin that is on a beneficiary’s Part D plan’s formulary will have a maximum monthly copay of $35 and will be covered before the individual reaches the plan’s deductible (if any). In addition, should someone taking insulin reach Catastrophic Coverage, the insulin would be covered in full for the remainder of the calendar year.

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